Reproductive Rights Prof Blog

Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota

Sept. 10, 2019 (CBS News): Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota, by Kate Smith: 

Legislators in North Dakota recently mandated physicians tell patients who are receiving medication abortions that the procedure may be reversed. North Dakota House Bill 1336 bases its text "on a pair of studies that have been contested by The American Medical Association and the American College of Obstetrics and Gynecology." 

Judge Daniel Hovland, on Tuesday, September 10, issued a 24-page decision granting an injunction against the bill, which he said is "devoid of scientific support, misleading, and untrue." Further elaborating that:

'State legislatures should not be mandating unproven medical treatments, or requiring physicians to provide patients with misleading and inaccurate information...The provisions of [Bill 1336] violate a physician's right not to speak and go far beyond any informed consent laws addressed by the United States Supreme Court, the Eighth Circuit Court of Appeals, or other courts to date.'

The lawsuit against the Bill was filed by the American Medical Association and Red River Women's Clinic. Red River is North Dakota's only legal abortion provider. According to research conducted by the Guttmacher Institute, people seeking abortions in the state must, in addition to very likely traveling long distances to reach the clinic, "undergo a state-mandated 24-hour waiting period." Minors may not receive an abortion in North Dakota without notifying their parents, and the state limits the ways a private insurance provider may cover the procedure. 

A separate North Dakota state law "requires physicians to tell patients that abortion terminates 'the life of a whole, separate, unique, living human being.'" The AMA and Red River suit also challenges this law, but the court has not yet addressed this claim, thus far only issuing the preliminary injunction against House Bill 1336.

Democratic governors warn: We'll pull our states out of Title X

July 31, 2018 (Politico): Democrats warn: We'll pull our states out of Title X, by Dan Diamond:

Three Democratic governors are threatening to pull out of the Title X federal family planning program if the U.S. Department of Health & Human Services (HHS) moves forward with its proposal to prohibit referrals for abortion care and make other changes that would exclude abortion providers from participating in the program.

Washington state Governor Jay Inslee, Hawaii Governor David Ige, and Oregon Governor Kate Brown said in separate statements that if the legal battle to prevent the Trump administration's Title X changes fails, their states would not be able to participate in the “unethical” Title X program.

“We would be left with no choice but to refuse to participate in an unethical Title X program," Inslee said in a statement Monday. “Hawai‘i will not accept federal funds for these programs if the proposed rules are implemented,” Ige said. “It would leave me no choice but to act in the best interests of the citizens of Oregon and our state law, and withdraw our state’s participation from an unethical, ineffective Title X program that reduces access to essential preventive health services,” Brown said.

New York Governor Andrew Cuomo issued a similar warning that his state's program would be "impossible" to continue, although he did not explicitly vow to pull New York out of the program.

The moves intensify a quickly escalating battle between the Trump administration and Title X program participants that also offer abortion care over the future of the family planning program. The deadline for public responses to the Trump administration's proposed changes was Tuesday, July 31.

Attorneys general from California, Connecticut, Delaware, Hawai'i, Illinois, Iowa, Maine, Maryland, Minnesota, New Jersey, New Mexico, North Carolina, and the District of Columbia on Monday also jointly issued a comment in opposition to the proposed rule, which can be found here.

7th Circuit panel affirms order blocking Indiana ultrasound abortion law

July 26, 2018 (Indianapolis Star): Court says women have 'ability to reason' in upholding block on abortion waiting period, by Vic Ryckaert:

A three-member panel of the 7th Circuit Court of Appeals on Wednesday upheld an injunction blocking an Indiana law that requires women to undergo an ultrasound and wait 18 hours before seeking abortion care.

The panel found that the 18-hour waiting period imposes an "undue burden" on women seeking abortion care.

"Women, like all humans, are intellectual creatures with the ability to reason, consider, ponder and challenge their own ideas and those of others," Judge Ilana Rovner wrote in the 51-page ruling. "The usual manner in which we seek to persuade is by rhetoric, not barriers."

Indiana Attorney General Curtis Hill said he is reviewing the decision.

Opponents of access to safe and legal abortion blamed a rise in Indiana abortions last year, the first since 2009, on U.S. District Judge Tanya Walton Pratt's 2017 ruling that blocked the ultrasound requirement. The restriction was included in a state law passed in 2016 and signed into law by then-Governor Mike Pence.

The ACLU filed the case on behalf of Planned Parenthood of Indiana and Kentucky, arguing that an 18-hour wait would force those seeking abortion care to take two days off work and pay for additional travel or overnight lodging expenses.

“The ruling affirms that deeply personal decisions about abortion should be made by women in consultation with their doctors, not politicians pursuing an extreme ideological agenda,” Jane Henegar, executive director of the ACLU of Indiana, said in a statement.

ACLU of Indiana legal director Ken Falk described the ruling as "a victory for women and another repudiation of the unnecessary and unconstitutional attempts by Indiana politicians to interfere with women’s reproductive rights.”

HHS Refuses to Release Documents on the New Office of Civil Rights (OCR)

The Department of Health and Human Services (HHS) announced the opening of a new division in January of this year: The Office of Civil Rights (OCR). The OCR's primary mandate is to enforce refusal of care laws. 

Refusal of care laws essentially empower medical providers to deny care to patients if they disagree with the ethics of a particular procedure based on their religious grounds. The purported goal of these laws is to protect a healthcare provider from being forced into providing care that "violates their conscience." 

This is an Executive-ordered decision that does not require legislative or judicial approval to go into effect or to implement its new rules and regulations.

Critics of refusal of care laws express concern that these requirements do not simply "protect" health care providers consciences, but can instead seriously harm patients. These laws may lead to a pharmacist refusing to fill a birth control prescription, a doctor refusing hormone therapy to a transgender patient, limitations placed on services to LGBTQ persons and partners, and of course abortion services may also become more limited.

HHS does not require providers who refuse treatment to refer patients to other providers or provide any information at all on other providers.

The OCR further has authority to initiate compliance reviews of any organization receiving federal funding to ensure conformity to the new rules. 

Earlier this month, the Center for Reproductive Rights (CRR) and the National Women's Law Center (NWLC) filed a lawsuit against HHS for refusing to release records pertaining to the creation of the OCR. The organizations initially requested these records via a FOIA request in January 2018. The CRR and NWLC seek knowledge of why the new division was needed, how the OCR operates, allocates funding, and may be influenced by outside groups.

"We’re filing this lawsuit to force the Trump-Pence administration to justify why it’s using resources to fund discrimination, rather than to protect patients," said Gretchen Borchelt, NWLC Vice President for Reproductive Rights and Health. 

HHS's new Office of Civil Rights follows additional moves by the Trump administration to limit equitable access to reproductive health care, including promoting the "Global Gag Rule," its domestic counterpart, and establishing regulations aimed at severely limiting funding to Title X programs. 

Giving Limited Advice at Crisis Pregnancy Centers

New York Times (Feb. 11, 2016):  Pregnancy Clinics Fight for Right to Deny Abortion Information, by Erik Eckholm:

At more than 3,000 crisis pregnancy centers (CPCs) run by religious opponents of abortion, a woman cannot obtain information on where to obtain an abortion.  To fight a California law requiring such centers to post a notice that free or low-cost abortion, contraception and prenatal care are available to low-income women through public programs, some CPCs are claiming a free-speech right to withhold such information.  Attempts in other states to regulate CPCs in this fashion have been struck down by federal courts.  But courts in California have so far refused to enjoin the regulations, the theory being that they do not force the CPCs to declare their religious beliefs but merely require them to provide factual information about public programs.  There are lingering concerns that CPCs are misleading pregnant women with false information about the complications of abortion and its longer-term effects.      

 

 

K.C. Becker on the Battle for Women's Reproductive Rights

Daily Camera: Battle for Women's Reproductive Rights Goes on Every Day, by K.C. Becker:

State legislatures across the country have become popular battlegrounds for limiting reproductive freedom for women. Anti-choice activists have been launching well-coordinated assaults in state after state by churning out bills designed to indirectly limit or eliminate a woman's legal right to get an abortion. These new laws shut down clinics by putting new requirements and restrictions on the clinics, doctors, or patients.

Becker predicts that some of these restrictions will eventually be declared unconstitutional.  "But rest assured" she warns, "that they will be coming back, across the country, with new variations on an old theme."  Becker reminds us that the battle did not end with Roe v. Wade.

 

New Oklahoma and Florida Abortion Waiting Period Laws Join This Year's "Flurry of Roadblocks"

The New York Times: State Legislatures Put Up Flurry of Roadblocks to Abortion, by Frances Robles:

Oklahoma’s governor this week approved a law extending to 72 hours the mandatory waiting period before a woman can have an abortion. Here in Florida, lawmakers enacted a 24-hour waiting period that requires two separate appointments — one for anultrasound and information about fetal development and another for the actual procedure.

These are just two laws in a surge of bills passed by Republican-controlled state legislatures this year that make it harder for women to have abortions. . . .

Arkansas Joins Arizona with New Law Requiring Information About Unproven "Abortion Reversal" Procedure

The Washington Post: In Arizona, Arkansas, women must be told that abortion can be ‘reversed’, by Sandhya Somashekhar:

New laws in Arkansas and Arizona require doctors to inform women that drug-induced abortions can be “reversed” mid-procedure, a claim that quickly drew charges of “junk science” from abortion-rights groups and many doctors.

The Arkansas law took effect late Monday, after Gov. Asa Hutchinson (R) signed it. Arizona Gov. Doug Ducey (R) signed his state’s bill into law earlier this month. . . .

New Arizona Law Would Require Providers to Tell Patients About Unproven "Abortion Reversal" Process

U.S. News & World Report: Arizona Abortion Law Pushes Boundaries of What Providers Must Tell Patients, by Tierney Sneed:

An unprecedented abortion law signed by Arizona's governor this week would require providers to inform patients that a drug treatment to end pregnancy may be reversed midway through – a mandate pro-abortion rights activists are denouncing as the latest effort by a state to employ questionable science in a politically motivated effort to discourage women from undergoing the procedure. . . .

By and large, the medical community has lined up against the Arizona law.

“Claims of medication abortion reversal are not supported by the body of scientific evidence,” the American Congress of Obstetricians and Gynecologists has said. . . .

4th Circuit Panel Unanimously Rules NC Pre-Abortion Ultrasound Law Unconstitutional; State Vows to Seek Supreme Court Review

Slate: North Carolina’s Outrageous Abortion Requirement Is Struck Down, by Dahlia Lithwick:

A conservative judge sticks up for medical ethics and the First Amendment.

A panel of the 4th Circuit Court of Appeals voted today to strike down a highly controversial North Carolina law requiring doctors and ultrasound technicians to perform an ultrasound, display the image of the sonogram, and specifically describe the fetus to any pregnant woman seeking an abortion, even if the woman actively “averts her eyes” and “refuses to hear.” The American Civil Liberties Union, the Center for Reproductive Rights, Planned Parenthood Federation of America, and others challenged the law, which was enjoined last year by a lower federal court.

Today, in a unanimous decision authored by Judge J. Harvie Wilkinson III, a three-judge panel affirmed a lower court’s determination that the law is a compelled speech provision that violates the First Amendment rights of providers. . . .

The Washington Post: N.C. abortion restriction violates free speech, judges rule, by Sandhya Somashekhar:

. . . Several other states, including Virginia, have ultrasound requirements, with some requiring women to undergo internal “transvaginal” ultrasounds before obtaining an abortion. Only a handful, however, have gone so far as North Carolina, and courts have had mixed opinions about such laws,upholding them in Texas and striking them down in Oklahoma.

On Monday, the North Carolina attorney general’s office said they would ask the Supreme Court to take up the matter to resolve the conflicting opinions in Texas and Richmond. . . .

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The opinion is available here.

Missouri Republicans Override Veto to Enact 72-Hour Waiting Period for Abortions

Kansas City Star - The Buzz blog: Missouri Republicans override Gov. Jay Nixon’s veto of 72-hour abortion waiting period, by Jason Hancock:

Missouri Republicans made history late Wednesday night, turning to a rarely-used procedural move to kill a filibuster and force into law a bill tripling the waiting period to have an abortion.

Senate Minority Leader Jolie Justus, a Kansas City Democrat, led a filibuster of the bill that requires women to wait 72-hours after consulting a doctor before having an abortion. The current waiting period is 24 hours. There is no exception for victims of rape or incest. . . .

Missouri Governor Vetoes 72-Hour Waiting Period for Abortions

ACLU press release: Nixon Vetoes Bill Forcing Women to Further Delay Abortions, Hearing Outcry from Missouri Women:

Jefferson City, Mo. – Hearing the voices of Missouri women, Governor Jay Nixon has vetoed a bill that would have forced a woman who has already met with her health care professional and decided to have an abortion to delay getting the medical care she needs for at least 3 days. Last month, women and men gathered in front of the capitol for 72 hours in protest of the bill.

"Missouri women have been clear: They are beyond fed up with legislators playing politics with their health," said Jennifer Dalven, director of the ACLU Reproductive Freedom Project. "Governor Nixon has shown that he understands that extreme politicians can’t be allowed to interfere with a woman’s ability to get an abortion just because they disagree with her decision."

A woman who decides to have an abortion has already carefully considered her decision. Bills that create additional wait times force a woman to make an extra trip to the state’s only clinic. This is especially burdensome for low-income women and rural women, who often can’t take extra days off work or travel long distances.

Extremist politicians in Missouri, who are already criticizing Gov. Nixon for standing up for women’s health, continue to show they care more about politics than women. This legislative session alone, Missouri politicians introduced more than two dozen bills designed to restrict access to abortion. Earlier this year, Missouri Rep. Chuck Gatschenberger compared a woman’s decision about whether to continue a pregnancy to buying a new car or carpet. 

Talking Points Memo:  Why Gov. Jay Nixon’s Anti-Abortion Bill Veto Matters, by Robin Marty:

Missouri Gov. Jay Nixon (D) has vetoed a 72-hour waiting period between an initial consultation and an abortion, stopping the state from becoming the third to implement a three-day waiting period for a pregnancy termination. While the veto is fantastic news for women who are pregnant and wants to obtain an abortion in Missouri or the surrounding area, it is even better news for reproductive rights activists overall, as it signals a noticeable shift in the political waters when it comes to opposing abortion. . . .

Missouri Legislature Sends 72-Hour Waiting Period Bill to Governor

CNN: Missouri lawmakers approve three-day abortion waiting period, by Faith Karimi & Jennifer Feldman:

Missouri lawmakers gave final approval to a measure that requires a woman to wait 72 hours from her initial doctor's visit before she gets an abortion.

The Republican-controlled House voted 111-39 in favor of the legislation late Wednesday.

Gov. Jay Nixon, a Democrat, has not said whether he'll sign it. . . .

Maps of Abortion Restrictions by State

A map of seven abortion restrictions on abortion access as of May 14, 2014, is available at:

FiveThirtyEight: Maps of Access to Abortion by State, by Allison McCann.

Missouri Senate Passes 72-Hour Waiting Period for Abortions

ACLU news release:  Ignoring Women’s Protest, Missouri Senate Passes Bill Tripling Time Women Must Delay their Abortions:

Jefferson City, Mo. –In the face of a substantial overnight protest on the capitol steps, early this morning the Missouri Senate passed a bill that forces a woman who has already met with her health care professional and decided to have an abortion to delay getting the medical care she needs for at least 3 days.   Missouri law had already required women to delay their abortions for 24 hours. The bill now goes back to the House, which has already passed a similar bill.

Women have been gathering in front of the capitol since 2 p.m. Monday for an ongoing filibuster in protest of the bill. They stayed throughout the night and have vowed to continue their protest for 72 hours.

“Once again, legislators are interfering with a personal, private decision made by a woman with her family and her doctor,” said Jennifer Dalven, director of the ACLU Reproductive Freedom Project. “It’s time for all of us to take out our pink Wendy Davis sneakers and let our elected representatives know that we won’t stand by while they play politics with women’s health.”  

This legislative session alone, Missouri has considered more than two dozen bills designed to prevent a woman from getting an abortion. Earlier this year, Missouri Rep. Chuck Gatschenberger compared a woman’s decision about whether to continue a pregnancy to buying a new car or carpet. 

In fact, women who decide to have an abortion have already carefully considered their decision. There is only one health center in Missouri that provides abortions. This law forces women to make additional trips to the clinic which makes it more costly for women and forces them to find additional child care and take additional days off of work. 

This is especially burdensome for low-income women and rural women, who often can’t take extra days off work or travel long distances.

If this bill becomes law, Missouri will join South Dakota and Utah as the only states with a 72-hour forced waiting period. 

Missouri Activists Stage 72-Hour "Women's Filibuster" To Protest 72-Hour Waiting Period Bill

MSNBC: LIVE NOW: 72-hour Missouri abortion filibuster, by Irin Carmon:

Missouri progressive activists are staging a nonstop, 72-hour “women’s filibuster” on the steps of the Missouri State Capitol building today to protest an abortion bill that would force a woman to wait three days between two clinic visits before having an abortion.

The activists’ hope is to prevent Republicans in the state Senate from breaking a Democratic filibuster on the bill, which already passed the House. The legislative session ends Friday. . . .

North Carolina Will Appeal Ruling on Pre-Abortion Ultrasound Mandate

News & Observer: Attorney general says North Carolina will appeal abortion ultrasound ruling, by Craig Jarvis:

Attorney General Roy Cooper said Friday that the state will appeal a federal judge’s ruling that strikes down the narrated ultrasound provision of an abortion-regulation bill.

“While I oppose laws like this that force the state into women’s medical decisions, the state will appeal this ruling because legitimate constitutional questions remain that should be decided by a higher court,” Cooper said in a statement his office released. “It is the duty of the Office of Attorney General to defend state laws regardless of whether I agree with them.” . . .

____________________________________

North Carolina Governor Pat McCrory recently expressed his opposition to an appeal.

Study Shows Pre-Abortion Ultrasounds Do Not Dissuade Women from Abortion

abcNEWS.com: Viewing Ultrasound Unlikely to Deter Women from Abortion, Study Finds, by Gillian Mohney:

A new study has found that pregnant women who plan on having an abortion are not often dissuaded by viewing an ultrasound.

The study, designed to find out if pregnant women who view their ultrasounds are significantly less likely to go through with a planned abortion, was published this month in the Obstetrics and Gynecology Journal. It looked at the cases of more than 15,000 women, the total number of pregnant women who went to a Planned Parenthood clinic in Los Angeles in 2011 and were planning to have an abortion. . . .

N.C. Governor Opposes Appeal of Ruling Invalidating Pre-Abortion Ultrasound Requirement

wsoctv.com: Gov. McCrory against appealing NC abortion speech case, by Emery P. Dalesio:

North Carolina Gov. Pat McCrory opposes a court fight to reverse a federal judge's ruling invalidating part of a state law that would have required abortion providers to describe a pre-procedure ultrasound's image to every patient, the Republican governor's office said Saturday. . . .

Federal District Court Declares North Carolina Pre-Abortion Ultrasound Law Unconstitutional

JURIST: Federal judge rules North Carolina abortion ultrasound law is unconstitutional, by Bradley McAllister:

A judge for the US District Court for the Middle District of North Carolina[official website] on Friday ruled [opinion, PDF] that a North Carolina state law requiring women seeking an abortion to undergo an ultrasound procedure is unconstitutional because it violates the First Amendment rights [LII backgrounder] of physicians and patients. The lawsuit was brought by several North Carolina physicians and health care providers on behalf of themselves and their patients as a challenge to the constitutionality of a state law passed in 2011. The Woman's Right to Know Act [materials] required women to have an ultrasound administered and explained by a medical professional at least four hours before she would be permitted to undergo an abortion. Also, the law mandated that images of the ultrasound be displayed so the woman could view them and a medical professional must offer the woman the opportunity to hear the fetal heart tone. . . .

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If the Fourth Circuit affirms this ruling, there will be a Circuit split on the issue.  In January 2012, the Fifth Circuit ruled in Texas Medical Providers Performing Abortion Servs. v. Lakey that plaintiffs were unlikely to prevail in their First Amendment challenge to a similar law, vacating a preliminary injunction granted by the district court.  On remand, the district court granted summary judgment in favor of the state based on the Fifth Circuit's ruling.  The Supreme Court declined an opportunity to consider the constitutionality of pre-abortion ultrasound requirements when Oklahoma appealed a state supreme court ruling striking down its law.  An affirmance by the Fourth Circuit, paired with the Fifth Circuit's contrary ruling, may prompt the Court to take up the issue.

-CEB